Microbiology of surgical site infections after gastrointestinal surgery in the south region of The Netherlands.

Aim: To give an overview of the microbiology of blood and wound samples from surgical site infections (SSIs) after gastrointestinal surgery, as well as the antimicrobial susceptibility of the microorganisms involved, and to discuss the appropriateness of the prophylactic antibiotics administered.

Materials & Methods: During a 3.5-year study period, wound swabs and blood samples of patients with an SSI were taken in the first 48 h after surgery until 30 days thereafter.

Cross-sectional study on surveillance of surgical site infections after vascular surgery.

Aims: To determine the incidence and risk factors for surgical site infections (SSI) after vascular surgery, to evaluate the Dutch safety bundle to reduce adverse complications and to analyze causative microorganisms of SSIs.

Materials & Methods: The 3.5-year study was divided into two periods: the control period (before bundle implementation) and intervention period (after implementation).

Outcome of nonheart-beating donor kidneys with prolonged delayed graft function after transplantation.

Nonheart-beating donor (NHBD) kidneys are frequently associated with delayed graft function (DGF), with a deleterious effect on kidney function and allograft survival. The influence and the duration of DGF on the outcome of NHBD kidneys are assessed. All recipients of an NHBD kidney in the period 1993-2003 were reviewed.

Vitamin K status and parenteral nutrition; the effect of Intralipid on plasma vitamin K1 levels.

Parenteral nutrition may affect the patient's vitamin K status. This imposes a risk when using drugs that interfere with the vitamin K-dependent clotting factor synthesis, such as N-methyl-thiotetrazole-containing cephalosporins. Intravenous lipid emulsions based on plant oils may contain phylloquinone (vitamin K1).

Perioperative nutritional support: a randomised clinical trial.

Ever since methods of artificial nutritional support became available, attempts have been made using this form of treatment to reduce mortality and morbidity in surgical patients. Many trials have addressed this question, but very few have given a meaningful answer because of conceptual and methodological flaws. We therefore undertook a prospective randomised trial investigating the effects of at least 10 days pre-operative total parenteral nutrition (TPN) (n = 51) or total enteral nutrition (TEN) (n = 50) providing 150% basal energy expenditure (BEE) non-protein energy, to reduce major postoperative complications and mortality in a homogeneous patient group with signs of depletion.

Resting energy expenditure in patients with newly detected gastric and colorectal cancers.

Resting energy expenditure (REE) was measured in 104 patients with newly detected gastric or colorectal (GCR) cancer and was compared with two groups of control subjects without cancer: healthy subjects (H control subjects) and patients with nonmalignant diseases of the gastrointestinal tract (GI patients). REE in GCR-cancer patients was not significantly different from REE in GI patients or H control subjects. Comparison of measured REE with predicted REE obtained from prediction equations may erroneously suggest that increased REE is a contributing factor in the development of cancer cachexia.

Prospective randomized double-blind trial of branched chain amino acid enriched versus standard parenteral nutrition solutions in traumatized and septic patients.

The addition of branched chain amino acids (BCAA) to total parenteral nutrition (TPN) solutions of balanced aminoacid composition has been reported to result in improved nitrogen balance, preservation of plasma protein levels, and improved immune function; however, only a few large clinical studies have been performed, yielding conflicting results. We, therefore, studied in a prospective, randomized double blind trial, the effects of BCAA enrichment of an otherwise isonitrogenous and isocaloric TPN solution on plasma protein levels in 101 traumatized and septic patients. TPN-derived nitrogen intake was similar in both study groups.

Effect of branched chain amino acid enrichment of total parenteral nutrition on nitrogen sparing and clinical outcome of sepsis and trauma: a prospective randomized double blind trial.

Administration of extra branched chain amino acids (BCAA) has been associated with a nitrogen sparing effect in septic and traumatized patients. Whether nitrogen sparing is associated with decreased morbidity and mortality rates is unknown. We therefore undertook a prospective, randomized, double blind trial investigating the effects of BCAA enrichment of a total parenteral nutrition (TPN) regimen on nitrogen balance, 3-methylhistidine excretion, morbidity as evidenced by disturbances in organ function, severity of sepsis and mortality.

Serum cobalamins and cobalamin-binding proteins during total parenteral nutrition.

Levels of serum cobalamin and both saturated and unsaturated serum cobalamin-binding proteins (transcobalamin II and R-binders) were determined prospectively in 43 patients before and after 2 weeks of total parenteral nutrition (TPN). Nine patients showed subnormal serum levels of cobalamin but none of them had clinical signs of cobalamin deficiency. Serum cobalamin levels significantly declined after 2 weeks of TPN as did both saturated and unsaturated R-binder levels whereas transcobalamin II levels remained constant.

Preoperative total parenteral nutrition (TPN) in severe Crohn's disease.

This study was performed to evaluate the effect of preoperative total parenteral nutrition (TPN) on the results after surgical treatment of patients with severe Crohn's disease. Of 67 patients admitted with complications of Crohn's disease, 51 had severe active disease and abdominal masses, fistulas and/or obstruction (mean Crohn's disease activity index score, 301). Forty-four patients received preoperative TPN for a mean period of 33 days.

Complications of central venous catheterization of the subclavian vein: the influence of a parenteral nutrition team.

Early and late complications of central venous catheterization were investigated in 488 consecutive catheters, 389 introduced in the subclavian vein by a percutaneous puncture technique, 84 by a cut down technique of the cephalic vein, and 15 by a peel away technique. Care and introduction of the catheters was controlled by the parenteral nutrition team in 239 cases. Immediate and late complications were found using both the puncture and venous cut down techniques, but immediate complications differed in the two groups due to the different methods of insertion.